thestaffindeliveryroomsfinallyhadconsistentstandardsfordeterminingwhichbabies
were in trouble, and the formula is credited for an important contribution to reducing
infant mortality. The Apgar test is still used every day in every delivery room. Atul
Gawande’srecentAChecklistManifestoprovidesmanyotherexamplesofthevirtuesof
checklistsandsimplerules.
TheHostilitytoAlgorithms
Fromtheveryoutset,clinicalpsychologistsrespondedtoMeehl’sideaswithhostilityand
disbelief.Clearly,theywereinthegripofanillusionofskillintermsoftheirabilityto
makelong-termpredictions.Onreflection,itiseasytoseehowtheillusioncameabout
andeasytosympathizewiththeclinicians’rejectionofMeehl’sresearch.
The statistical evidence of clinical inferiority contradicts clinicians’ everyday
experienceofthequalityoftheirjudgments.Psychologistswhoworkwithpatientshave
manyhunchesduringeachtherapysession,anticipatinghowthepatientwillrespondtoan
intervention, guessing what will happen next. Many of these hunches are confirmed,
illustratingtherealityofclinicalskill.
The problem is that the correct judgments involve short-term predictions in the
contextofthetherapeuticinterview,askillinwhichtherapistsmayhaveyearsofpractice.
The tasks at which they fail typically require long-term predictions about the patient’s
future.Thesearemuchmoredifficult,eventhebestformulasdoonlymodestlywell,and
theyarealsotasksthattheclinicianshaveneverhadtheopportunitytolearnproperly—
they would have to wait years for feedback, instead of receiving the instantaneous
feedbackoftheclinicalsession.However,the line betweenwhatclinicianscandowell
andwhattheycannotdoatallwellisnotobvious,andcertainlynotobvioustothem.They
knowtheyareskilled,buttheydon’tnecessarilyknowtheboundariesoftheirskill.Not
surprisingly, then, the idea that a mechanical combination of a few variables could
outperform the subtle complexity of human judgment strikes experienced clinicians as
obviouslywrong.
The debate about the virtues of clinical and statistical prediction has always had a
moral dimension. The statistical method, Meehl wrote, was criticized by experienced
clinicians as “mechanical, atomistic, additive, cut and dried, artificial, unreal, arbitrary,
incomplete, dead, pedantic, fractionated, trivial, forced, static, superficial, rigid, sterile,
academic,pseudoscientificandblind.”Theclinicalmethod,ontheotherhand,waslauded
by its proponents as “dynamic, global, meaningful, holistic, subtle, sympathetic,
configural,patterned,organized,rich,deep,genuine,sensitive,sophisticated,real,living,
concrete,natural,truetolife,andunderstanding.”
Thisis anattitudewe canall recognize.When a humancompetes witha machine,
whether it is John Henry a-hammerin’ on the mountain or the chess genius Garry
KasparovfacingoffagainstthecomputerDeepBlue,oursympathiesliewithourfellow
human.Theaversiontoalgorithmsmakingdecisionsthataffecthumansisrootedinthe
strongpreferencethatmanypeoplehavefortheormnaturaloverthesyntheticorartificial.
Asked whether they would rather eat an organic or a commercially grown apple, most
peoplepreferthe“allnatural”one.Evenafterbeinginformedthatthetwoapplestastethe